Islas et al: Lesión severa causada por la penetración traumática de un cepillo dental

SPECIAL GUEST LITERATURE REVIEW

Color Selection and Reproduction in Dentistry
Part 2: Light Dynamics in Natural Teeth
Reproducción y selección del color en Odontología
Parte 2: Dinámica de la luz sobre las piezas dentales
Received: 12-V-2016 Accepted: 19-V-2016 Published Online First: 24-V-2016

DOI: http://dx.doi.org/10.15517/ijds.v0i0.24493

ABSTRACT

In the first article of this trilogy, it was demonstrated the great importance of the light source in
the chromatic procedures and also the chromatic characteristics of color communication proposed by
Munsell. In this second article, the focus is in Geometric Attributes and Optical Properties of natural
teeth. The main features of translucency, opalescence and fluorescence will be described. According to
the interaction of light with natural dental tissues, the desired optical qualities of the esthetic restorative
materials will be associated.

KEYWORDS

Color; Translucency; Chroma; Opalescense; Fluorescense.

RESUMEN

En el primer artículo de esta trilogía, se demostró la gran importancia de la fuente de luz en los
procedimientos cromáticos y también sobre las características cromáticas del color propuestas por
Munsell. En este segundo artículo, la atención se centra en los atributos geométricos y las propiedades
ópticas de los dientes naturales. Se describirán las principales características de translucidez,
opalescencia y fluorescencia. Según la interacción de la luz con los tejidos dentales naturales se pueden
asociar las cualidades ópticas deseadas de los materiales de restauración estética.

PALABRAS CLAVE

Color; Croma; Translucidez, Opalescencia; Fluorescencia.

SCHMELING M., 2016: Color Selection and Reproduction in Dentistry. Part 2: Light Dynamics in Natural Teeth.-ODOVTOS-Int. J. Dental Sc., 18-2
(May-August): 23-40.
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23-40, 2016. ISSN:1659-1046. 23
TRANSLUCENCY OF NATURAL TEETH
Enamel and dentin have different structural
characteristics and, consequently, they exhibit
different light wave interaction characteristics.
Due to its highly mineralized prismatic structure,
low organic content and a small amount of water,
enamel has a higher transmission of light than
dentin; dentin has the less mineral content,
an organic tubular structure, higher water
content and is less translucent (Figs. 1 e 2) (1).
Differences in translucency of dental tissues can
be better understanding with the aid of polarizing
filters (Fig. 3 e 4).
Defined as the relative amount of light
transmitted through a material, the translucency
can be understood as an intermediate situation
between total blockage of light rays (opacity)
and overall transmission of rays (transparency).
Therefore, the translucent objects allow light to
pass through, varying this passage to a greater
or lesser degree (2-3). The chromatic evaluation
in translucent bodies is more complex than
in opaque bodies. Hue, chroma and value are
parameters considered insufficient to accurately
describe the optical effects observed in objects
that allow light transmission. For this reason, the
translucency is considered the fourth chromatic
dimension applied in restorative dentistry. In this
four-dimensional concept, the value is the most
important dimension of color with the translucency
coming in second place (4).
Generally, the translucency of resin
composites and ceramic systems is directly related
to its thickness. Several authors described that
the increase of thickness of restorative materials
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results in a decrease of its translucency (Fig. 5). It
is very important to discover what is the thickness
required by each material to block the influence of
the background contrast, an essential condition to
evaluate the inherent color of the material (2,5-7).
The maximum thickness of 4.0 mm was
described on a study by Kamishima and colleagues,
who reported that enamel composite resins were
not influenced by the background contrast at this
thickness (5). To match tooth color, various shades
of yellow and gray pigments are blended to white
base material of traditional resin composites. In
darker shades (low lightness or high chroma shade),
more pigments might be incorporated, which may
influence the translucency of the shade. Yu and Lee
analyzed the influence of color parameters of resin
composites on their translucency using a reflection
spectrophotometer. The results indicated a high
correlation between translucency and Value, with
darker shades presenting lower translucency (7).
Besides the thickness, another factor that
influences the translucency of the teeth is the
surface texture. It relates to the appearance of the
surface of objects, and in general, we can define it
into macro-and micro-textures. The macro-textures
are topographical variations found on the surface of
the enamel, such as the grooves of development.
The macro-textures are responsible for large areas
of light reflection. The micro-textures are formed
by tiny changes of enamel surface, occurring
by deposition of hydroxyapatite crystals by
ameloblasts during tooth germ formation, resulting
in small oriented parallel grooves. A rich parallel
groove surface is responsible for the creation of
areas of diffuse reflection on the tooth surface,
thereby, decreasing the translucency (Fig. 6) (8-9).
Figure 1 and 2. Note the different structural characteristics between enamel (left image) and dentin (right image).

Figure 3 and 4. The translucency differences of dental tissues can be better understanding with the aid of polarized filters.
Note that enamels acts like an optical fiber transmitting the light energy to dentin.

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Figure 5. The opacity of esthetic dental materials is directly related to its thickness where a larger thickness corresponds to high opacity.
In a study of the translucency of enamel,
some authors have shown that this property is
strongly influenced by the degree of hydration
of this tissue. In this study, the dehydration of
the enamel was evaluated instrumentally after
applying a jet of air for 10 seconds and resulted in
82% decrease in the values of translucency. This
decrease was due to the increase of the refractive
index of enamel caused by the water outflow and
air intake on the outskirts of the prisms (Fig. 7) (10).
In aesthetic dentistry, the importance of
translucency becomes evident when we observe
the variation of the color of teeth according to
background contrast (11). The same tooth observed
in a white background and a dark background,
will show different colors to due to absorption
and selective reflection of certain wavelengths.
Throughout this chapter we demonstrate the
influence of the background contrast in the color
of natural teeth with special attention in the incisal
region of the anterior teeth.
THE DYNAMICS OF COLOR IN RELATED TO AGE
A basic factor when studying tooth color is
the variation in thickness of these tissues due to
aging. In natural teeth, the value is characteristic for
the enamel, while the chroma and hue characterize
dentine. The younger individuals, less exposed to the
wear caused by the acids in the diet and brushing,
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present enamel thicker than older individuals, and
consequently lighter teeth. As wear is accentuated
and the thickness of the enamel layer decreases,
the translucency of the enamel increase, enabling
chroma and hue, characteristics concerning the
dentine, become more obvious. Thus, during
the process of interaction of light with the dental
tissues, enamel plays an important role in acting as
a filter, whose greater or less thickness accounts
for teeth brighter or less bright (Fig. 8) (12-13).
These characteristics can also be proven
by observing the color variation that exists in a
single tooth. Thus, at the cervical region, where
enamel is thin, the color is only attenuated and
chroma is high. In the middle third, which is more
thick, the enamel is able to filter significantly
the characteristics of dentin, making this region
with high brightness and low saturation in the
incisor region where there is little or even absent
dentine, hue and chroma are replaced by tooth
translucency and opalescence effect that will be
discussed below.
OPTICAL PROPERTIES OF DENTAL TISSUES
In addition to presenting different degrees
of translucency, enamel and dentin also have
different optical properties that give teeth unique
beauty, highlighting respectively the opalescence
and fluorescence.
OPALESCENCE
Opalescence is an optical property that
gets its name because it was first observed in
opal stones (Fig. 9) (14). It happens by scattering
of smaller wavelengths of the visible spectrum,
making the opalescent objects more bluish when
viewed under reflected light and more orange
when viewed in transmitted light (15). All teeth
that are naturally covered by the enamel present
opalescence (Figs. 10 e 11). However, this property
can be better observed in the upper central
incisors, in the form of a blue band, located near
to the incisal edge called opalescent halo (16-
17). Besides opalescent halo, the opalescence
also gives rise to another optical phenomenon
called counter-opalescence, (17-18) responsible
for orange appearance that can be observed in
the region of the mamelons tip of anterior teeth.
It happens when the greater wavelengths, which
are usually transmitted through the enamel, reach
structures capable to reflect them. When the light
performs inverse path through the enamel, the
blue wavelength still being spread while larger
lengths are transmitted, making the dentin more
orange (Fig. 12).
Due to its great aesthetic importance, the
opalescence was considered by some authors
as a chromatic scale can be recognized by four
different types of presentation (18).
• Type 1: Found in incisal edges that have
opalescent halo closely related to the dentinal
mamelons. It kind of opalescence presented by
58% of individuals (Fig. 13).
• Type 2: In this type of opalescent halo mamelons
not penetrate between the dentin, extending
over the incisal edge. It kind of opalescence
presented por17% of individuals (Fig.14).
• Type 3: Found in incisal edges showing diffuse
halo opalescent, distributed randomly throughout
the incisal edge. It kind of opalescence presented
by 4% of subjects (Fig. 15).
• Type 4: In this type of opalescence opalescent
halo presents mixed with some kind of
pigmentation or characterization. It kind of
opalescence presented by 25% of subjects.
Baratieri, Araujo, Monteiro JR (2005),
demonstrated that removing the vestibular enamel
of central incisors extracted, the of mamelon
tip showed white opaque color than the original
orange color, showing the influence of the counter-
opalescence in the appearance of the tooth (19).
By understanding the role and importance of
opalescence and counter-opalescent we realize
that the enamel contributes decisively in the
expression of subtle variations of hue observed in
natural teeth.
In ceramic systems, opalescence has been
responsible to solve aesthetic problems related
to value and translucency, making possible to
produce unnoticeable restorations (20-21). It has
been demonstrated that the opalescence helps
on the masking effect when the resins present
similar translucencies. However, when the
composite resins present different translucency
degrees, the translucency is predominant (22).
When these results are extrapolated to enamel, it
means that in spite of the opalescence decrease,
it is more important to evaluate changes of
translucency than of opalescence to determine
the potential of masking effect of this tissue.
The correct reproduction of opalescence with
composite resins involves careful observation of
adjacent teeth and the selection and application
of opalescent resins in appropriate locations. The
correct reproduction of opalescence with ceramic
systems also involves careful observation and
the use of opalescent ceramic, however, this
information should be forwarded to the technician
who performs the restoration.
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Figure 6. Surface texture of the upper central incisors. Note the large vertical elevations and depressions that are present on the tooth
surface as well as the smaller horizontal grooves that can be observed, mainly in younger individuals.

Figure 7. The enamel is strongly influenced by the degree of hydration. The left incisors were dehydrated allong 24 hours and became with
an white-opaque color (note that we can't see the black background contrast through it). The right incisors are observed after 5 minutes
under the water. Note the increase of translucency and the influence of the background contrast through hydrated enamel.

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Figure 8. The dynamics of color natural teeth related to age.

Figure 9. Opal stone observed under direct reflected light (left) and transmitted light. Note the blue shade
under reflected light and the orange shade under transmitted light.

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Figure 10. Central incisor slices observed under reflected and transmitted light in black background.. Under reflected light (left) we could
see bluish shades on enamel. Under transmitted light, enamel also shows an orange color.

Figure 11. For esthetic reasons, the anterior teeth are the most used examples to present opalescence. Nevertheless, opalescence is
present in all teeth. Observe that under transmitted light dentin also shows an orange color. This fact confirms the influence of translucency
on opalescence. Clinically we can confirm this affirmation observing the oranfe effect on tips of mamellons.

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 Figure 12. Schematic image of opaque halo (in the edge of incisal board- Orange color), opalescent halo (between opaque
halo and dentin mamelons -blue color ) and dentin mamelons At the center of tooth -yellow color.

Figure 13. Opalesccnce type 1. Figure 14. Opalescenve type 2.

Figure 15. Opalescence type 3. Figure 16. Opalescence type 4.

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Figure 17. Influence of background contrast on opalescence and counter-opalescence.

Figure 18. Removing the vestibular enamel of central incisors extracted, the of mamelon tip showed white opaque color than the original
orange color, showing the influence of the counter-opalescence.

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Figure 19. The correct reproduction of opalescence with composite resins involves careful observation of adjacent teeth and
the selection and application of opalescent resins in appropriate locations.

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FLUORESCENCE
Fluorescence is a luminescence phenomenon,
which means that it causes spontaneous light
emission by a process other than heating (23). To
better understand fluorescence, clinicians must
remember that all visible light is situated in a
narrow band of the electromagnetic field, limited
at the lower end by ultraviolet (UV) radiation and
at the upper end by infrared (IR) radiation. Both
radiations are invisible to the human eye. This
range is called the visible spectrum (24). While
most objects dissipate the absorbed light energy
as heat, fluorescent objects re-emit this energy
in a longer, visible wavelength at a speed faster
than 10-8 seconds (25-26). Although there is
evidence that dentin and cementum exhibit a red
color when they intercept the incidence of green
light, (27) tooth fluorescence is usually associated
with a blue-white chromatic appearance (Fig. 20)
caused by the incidence of the UV wavelength,
as is emitted by the black light present in most
nightclubs (28).
In this environment, the incidence of UV
wavelengths in a tooth restored with nonfluorescent
material causes metameric failure and is responsible
for highlighting the restorative material (29-30).
Fluorescence is present in both enamel and dentin;
however, because it is associated with the amount
of organic matter, it presents three times greater
intensity in dentin than in enamel (Figs 21 e 22)
(31). This difference results from the presence
of collagen fibers (32) and specifically the amino
acids that help to compose those fibers, including
tryptophan, pyrimidine, (33-34) and pyridinoline
(35). Under natural light, fluorescence makes teeth
more luminous and shiny, giving them an internal
luminescence (36). Fluorescence must be present
in restorative materials to obtain natural-looking
results. Indirect materials were the first to show
fluorescence. Currently, direct composite resin
and adhesive systems, which can be used even
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for extensive Class III or IV restorations, offer the
potential for suitably fluorescent results. Based
on the fluorescence observed in natural teeth, the
fluorescence of composite resins can be classified
as low, suitable, or excessive (Fig.23) (29-30).
When composite resin disks, of the same color
but different thicknesses, were compared they all
showed similar fluorescence (30, 37).
The different fluorescent properties of
composite resins can be better observed when
compared to a natural tooth (Fig 24). Observation
of the fluorescence of enamel has been described
as an effective alternative method for the initial
diagnosis of caries due to the low fluorescence
of decayed enamel compared to sound enamel.39
When human dentin was irradiated with light in the
range of 365 nm, fluorescence was observed with
a peak located at 440 ± 10 nm. (38).
Although dentin is primarily responsible for
the fluorescence of natural teeth, several authors
have suggested that the enamel composite resin
layer is more responsible for fluorescence of a
restoration. Thus, if the dentin layer comprises
highly fluorescent resin and the enamel layer
comprises nonfluorescent resin, the result will be a
nonfluorescent restoration. Conversely, if the enamel
layer exhibits high fluorescence and the dentin
resin layer does not, the result will be a fluorescent
restoration (Fig 25) (29-30, 38). The correct
reproduction of fluorescence with composite resins
involves the correct selection and application of
fluorescent resins in appropriate layer technique.
CONCLUSION
After reading the second article of this trilogy
we must comprehend the natural teeth as a dynamic
mosaic influenced by the interaction of different
variables, resulting in a unique and inconstant
beauty. Indeed, to obtain optimal esthetic results, the
restorative materials should present optical properties
that are similar to those of the dental structure.
Figure 20. Natural teeth as observed in daylight and black light.

Figure 21. Fluorescence of central incisor slices under daylight and black light. Because it is associated with the amount of organic matter,
note (under black light) that it presents three times greater intensity in dentin than in enamel.

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Figure 22. For esthetic reasons, the anterior teeth are the most used examples of fluorescence. Nevertheless,
it is present the same characteristics in all teeth.

Figure 23. Based on the fluorescence observed in natural teeth, the fluorescence of composite resins can be classified as low, suitable,
or excessive.

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Figure 24. Differences in resin composite fluorescence compared to an natural extracted teeth.

Figure 25. Schematic representation of the importance on the composite resin surface in fluorescence of restorations. Restoration A and
restoration B show fluorescence, while restoration C and D do not.

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 Figure 26. The correct reproduction of fluorescence with composite resins involves the correct selection and application
of fluorescent resins in appropriate layer technique.

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Max Schmeling DDS, MS, PhD¹

1. Federal University of Santa Catarina (UFSC), Brazil.

Collaborator Professor of Federal University of Santa Catarina (UFSC), Brazil.
Head of Operative Dentistry Department of Central Dental Clinics of Brazilian Army -
OCEx, Rio de Janeiro, Brazil.
Email: bluemax@globo.com

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